Truth, Lies, and Ophthalmology

Tips for the ophthalmologist confronted with functional vision loss

Valerie Purvin
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02/02/2017

When dealing with functional vision loss, knowing the correct terminology is the first step. We use the terms “functional,” “non-organic” or “non-physiological” vision loss to describe patients who appear to be describing problems that don’t appear to have a physical basis. But bedded within this larger term are subgroups – patients who have had a conversion reaction, in which visual loss is unconscious or involuntary, versus those who may be malingering or have factitious disorder (meaning there is deliberate, feigned visual loss, which may have various motives). But we don’t use these terms – just larger blanket terms, such as “non-organic.” Why?

The first and perhaps most important reason is that to make a distinction is to speak to the state of mind of the patient. And should you end up on the witness stand or in deposition with a lawyer, you don’t want to find yourself being quizzed on your psychiatric credentials. It’s not our area of expertise. We don’t want to assume we know why our patient is behaving in this way. The second reason is that such behavior exists on a spectrum, so the reasons for the patient’s behavior may not be so black and white; for example, a patient may have genuinely experienced a small amount of visual impairment, but then exaggerated their symptoms because they want to make sure their doctor doesn’t miss it. In any case, understanding the distinction is valuable for the management of these patients.

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About the Author

Valerie Purvin

Valerie Purvin has been on the faculty of the Indiana University Medical Center for over 30 years with a busy clinical practice in a large, subspecialized ophthalmology group in Indianapolis, Indiana, USA. She has published on a range of topics, generally focusing on issues that arise in caring for patients with neuro-ophthalmic disorders including ischemic optic neuropathy, inflammatory optic neuropathies, and visual complications of medications.